The impact of Medicaid funding structures on inequities in health care access for Latinos in New York, Florida, and Puerto Rico

• Published in: Health services research 2022-12, Vol.57 (S2), p.172-182
• Main Authors: Rivera‐González, Alexandra C., Roby, Dylan H., Stimpson, Jim P., Bustamante, Arturo Vargas, Purtle, Jonathan, Bellamy, Scarlett L., Ortega, Alexander N.
• Format: Article
• Language: English
• Subjects: Citizens; Company business management; Cross-Sectional Studies; Data collection; Delayed; Economic aspects; Florida; Funding; Government programs; Health care; Health care access; Health care disparities; Health disparities; Health insurance; Health Services Accessibility; Hispanic Americans; Hispanic or Latino; Households; Humans; Income; Insurance; Insurance Coverage; Insurance, Health; Latin American cultural groups; Management; Medicaid; medically uninsured; minority groups; New York; Patient Protection and Affordable Care Act; Polls & surveys; poverty; Public health; Puerto Rico; Risk analysis; Risk behavior; Risk factors; Risk taking; Surveillance systems; Surveys; United States
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.14036

Objective To study the impact of Medicaid funding structures before and after the implementation of the Affordable Care Act (ACA) on health care access for Latinos in New York (Medicaid expansion), Florida (Medicaid non‐expansion), and Puerto Rico (Medicaid block grant). Data Sources Pooled state‐level data for New York, Florida, and Puerto Rico from the 2011–2019 Behavioral Risk Factor Surveillance System and data from the 2011–2019 American Community Survey and Puerto Rico Community Survey. Study Design Cross‐sectional study using probit with predicted margins to separately compare four health care access measures among Latinos in New York, Florida, and Puerto Rico (having health insurance coverage, having a personal doctor, delayed care due to cost, and having a routine checkup). We also used difference‐in‐differences to measure the probability percent change of having any health insurance and any public health insurance before (2011–2013) and after (2014–2019) the ACA implementation among citizen Latinos in low‐income households. Data Collection The sample consisted of Latinos aged 18–64 residing in New York, Florida, and Puerto Rico from 2011 to 2019. Principal Findings Latinos in Florida had the lowest probability of having health care access across all four measures and all time periods compared with those in New York and Puerto Rico. While Latinos in Puerto Rico had greater overall health care access compared with Latinos in both states, health care access in Puerto Rico did not change over time. Among citizen Latinos in low‐income households, New York had the greatest post‐ACA probability of having any health insurance and any public health insurance, with a growing disparity with Puerto Rico (9.7% any [1.6 SE], 5.2% public [1.8 SE]). Conclusions Limited Medicaid eligibility (non‐expansion of Florida's Medicaid program) and capped Medicaid funds (Puerto Rico's Medicaid block grant) contributed to reduced health care access over time, particularly for citizen Latinos in low‐income households.